By Marlene Cimons
The Washington Post
David Kessler has declared war on what he calls “toxic waist,” the visceral abdominal fat linked to hypertension, Type 2 diabetes, heart disease, some cancers and even dementia.
“It’s the villain when it comes to chronic disease, and reducing it has the potential to save trillions of dollars and reduce much of the disability that occurs frequently in our older years,” said Kessler, a former commissioner of the Food and Drug istration. “Cardiologists, kidney specialists, oncologists and others are just waking up to that discovery.”
Kessler, a physician, served as FDA commissioner from 1990 to 1997 and as a top COVID-19 science adviser to President Joe Biden, co-leading Operation Warp Speed and overseeing vaccines, testing and boosters.
In recent years, Kessler has lost considerable weight himself with the help of the new GLP-1 drugs. He describes his weight loss and analyzes the drugs and their potential societal impact in his new book, “Diet, Drugs and Dopamine.”
Kessler, who is 5 feet 10 inches tall, dropped more than 60 pounds, going from a little over 200 pounds to 137 pounds, and he cut his body fat percentage in half, from 30 percent to 15 percent. But, he said, the drugs’ side effects were not pleasant.
“I lost my appetite. I felt bloated,” he said. “I had intense chills and had to wrap myself in an electric blanket. I felt sick. There was malaise and occasional sharp abdominal pains.”
Nevertheless, he stuck with it and saw his relationship with food and eating begin to change in dramatic ways along with his weight. His cravings for fat, salt and sugar mostly disappeared. He began regularly eating vegetables for the first time. He ate smaller portions but felt full. And his weight plummeted.
He thinks these medications, which are taken by self-injection and work by slowing the emptying of the stomach, could halt the trajectory of chronic disease in the United States if used under medical supervision and by the right people. Many insurance plans, including Medicare, won’t cover them for weight loss, and they cost about $1,000 a month, Kessler said. He paid out of pocket for them, he said. And most people who stop them can eventually gain the weight back, so it’s possible many people will need to be on them for the rest of their lives, if they can tolerate them.
The Washington Post spoke to Kessler about the promise and perils of these drugs and his own feelings ing them. His responses have been lightly edited for style and clarity.
Q: Why is this visceral fat so bad for us?
A: Visceral fat is hidden fat that surrounds your vital organs. It leaks out chemicals — fatty acids — and generates chronic inflammation, a major health risk factor. It also promotes elevated levels of insulin, called hyperinsulinemia, because of insulin resistance. When the body’s ability to use insulin is impaired, it can lead to higher blood sugar and a greater risk of Type 2 diabetes. Hyperinsulinemia has increased among Americans from 28 percent in 1999 to 41.4 percent in 2018. These drugs provide an opportunity to reverse this.
Q: What kind of impact would it have on the health of the country to eliminate this abdominal fat?
A: Massive. If you want to make America healthy again, this is the way to do it.
Q: What prompted you to start using these drugs?
A: I have battled my weight for my entire life. I was using food to change how I feel. To calm me down. To increase my focus. To keep me going. Food is very powerful, but it has consequences. The mistake I would always make is that I would lose weight and then gain it back. It’s like trying to push a life preserver under water. It keeps coming back up no matter how hard you keep pushing it down.
Q: And now?
A: I’ve used the drug in cycles. I was on the drug for about seven months, then off, then back on, then off. I’m off it now, but I have conditioned myself to eat less. When I was on these drugs, ultraformulated foods made me feel ill. These are foods that are formulated to trigger the reward system and are the perfect trifecta of fat, sugar and salt. Also, I no longer want to eat large portions.
Q: But how do you maintain weight loss when you are off the drug?
A: Here’s the key: If food stays in your stomach longer, you can feel sick. People on these medications often eat less to avoid the ill effects of food staying in their stomach longer. You have to relearn how to eat, and that’s what these drugs help you do.
Q: Why do these medications make you feel ill?
A: The drugs work in significant part by triggering gastrointestinal effects, keeping food in the stomach longer and generating feelings that push us to the edge of nausea – and sometimes outright nausea. They counterbalance the rewarding and addictive properties of food and reduce the food “noise,” or incessant wanting, that plays in our heads.
Q: Why do people stop using weight-loss drugs?
A: There are side effects, some of them potentially dangerous. For example, malnutrition or gastroparesis, which occurs in some patients taking the drugs and results from the delayed emptying of the stomach into the small intestine, causing nausea, pain and other digestive issues. Another thing is that people don’t want to be injecting themselves forever. Finally, they are expensive, and insurance doesn’t always cover them or coverage stops.
Q: Who are the best candidates for these drugs?
A: If you have this abdominal visceral fat, and conditions such as hypertension, elevated lipids or glucose, Type 2 diabetes or prediabetes, talk to your health-care provider about the risks and benefits of taking these drugs. These drugs are potent. Using them, your body fat loss could be double that achieved through diet and exercise. This doesn’t mean you shouldn’t exercise, which does a lot of good things for your health, or stop eating healthy foods.
Q: Finally, do you see another cycle of these drugs in your future?
A: We need more data on the safety and efficacy of intermittent use. The FDA should require drug companies to provide it. For me, it’s a journey. If I find myself out of balance, I certainly will consider using the drugs again.
